Kristina Lah Tomulić

Laryngeal cyst and tracheomalacia in neonate: coincidence or complication?

The authors are presenting a case of a female infant with a large congenital laryngeal cyst. After operation, tracheomalacia with inspiratory stridor has been noticed.

Premature twins with acute renal injury – it is not always what it seems to be

Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unifi ed defi nition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother’s value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother’s unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother’s renal function.

Nedonešeni blizanci s akutnim oštećenjem bubrega– nije uvijek kako se čini: prikaz slučaja

Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unifi ed defi nition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother’s value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother’s unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother’s renal function.

Premature twins with acute renal injury– it is not always what it seems to be:case report

Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unifi ed defi nition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother’s value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother’s unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother’s renal function.

Acute respiratory distress syndrome in an 11-month-old girl leading to extracorporeal membrane oxygenation

Acute respiratory distress syndrome (ARDS) is a condition recognised for almost fifty years, and is related to high morbidity and mortality in children. From its recognition, medical experts tried to make joint efforts to make recommendations and optimize treatment in children and adult population. The new definition of ARDS suggests treatment by introducing three levels of severity, according to PaO2/ FiO2 and positive end-expiratory pressure. Lung-protective ventilation remains crucial in achieving better outcome in paediatric acute respiratory distress syndrome (PARDS), but promising therapies based on paediatric studies include non-invasive ventilation, endotracheal surfactant, highfrequency oscillatory ventilation (HFOV), and use of ECMO as „rescue“ therapy. Nevertheless, PARDS is a real challenge for the paediatric critical care provider, and even if current state-of-the-art treatment methods are delivered, this disease often leads to fatal outcome. We report the case of an 11-month-old female infant who developed ARDS, was treated by current up-to-date treatment methods, including ECMO, and despite this, succumbed to her illness. With this case report we would like once more to bring to consideration the current knowledge on etiology, epidemiology, diagnosis and treatment of ARDS in children, and emphasize the high morbidity and mortality related to this syndrome.

Mediastinal tube placement in a premature infant with cardiorespiratory derangement due to ventilator associated pneumomediastinum

While mediastinal free air in the ventilated newborn is usually benign, tension pneumomediastinum can lead to further cardiorespiratory compromise due to the compression of mediastinal structures, including the heart and large blood vessels. The authors present a case of life-threatening pneumomediastinum in a ventilated preterm leading to abrupt onset of cardiorespiratory failure. An 8 French (Fr) drainage catheter was placed in the anterior mediastinum using the 2nd right intercostal space as an insertion site, with prompt hemodynamic improvement. A brief description of the drainage technique and a literature review is presented. SANDRO DESSARDO • KRISTINA LAH TOMULI • NEVEN FRLETA • NADA SINDI I DESSARDO

Myotubular myopathy associated with hypoxic- ischemic encephalopathy as a cause of prolonged ventilatory dependency

KRISTINA LAH TOMULIC ( ) • SANDRO DESSARDO • MILJEN GAZDIK • NEVEN FLETA Pediatric Intensiv Care UnitDepartment of Pediatrics University Hospital Rijeka HR-51000 Rijeka, CROATIA, Istarska 43/3 Fax: ++385-(0)51-62 31 26 e-mail: k.lahtomulic